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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
48
VOLUME 16 NUMBER 2 • NOVEMBER 2019
High risk of falls in young to middle-aged adults
(20–55 years) with diabetes
VERA-GENEVEY HLAYISI, CHRISTINE ROGERS, LEBOGANG RAMMA
Correspondence to: Vera-Genevey Hlayisi
Division of Communication Sciences and Disorders, Department of Health
and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape
Town, South Africa
e-mail:
vera.hlayisi@uct.ac.zaChristine Rogers, Lebogang Ramma
Division of Communication Sciences and Disorders, Department of Health
and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape
Town, South Africa
S Afr J Diabetes Vasc Dis
2019;
16
: 48–52
Abstract
Background:
Falls, leading toaccidents or unintentional injury,
are the second most prominent cause of death worldwide,
and over 80% of fall-related fatalities occur in low-income
countries. Few investigations in South Africa have focused
on fall risk, specifically among young to middle-aged adults
(younger than 55 years of age) with diabetes.
Aims:
This study aimed to determine fall risk in young to
middle-aged adults (20–55 years of age) with diabetes and
compare it to those without diabetes. A secondary aim
was to determine the association between fall risk and
characteristics of diabetes, including type, duration (in
years), control (glycaemic status), age, gender and diabetes
co-morbidities (peripheral neuropathy and vision difficulties).
Methods:
A cross-sectional, matched-groups design with a
cohort (individuals with diabetes) and control (non-diabetic)
group was utilised. Assessments carried out in both groups
included: the Dynamic Gait Index (DGI), the Modified
Clinical Test of Sensory Integration (M-CTSIB), the Diabetic
Neuropathy Symptoms (DNS) score and a visual acuity
screen. Data were analysed using both descriptive and
inferential statistical tests.
Results:
A total of 192 participants between 20 and 55 years
of age were assessed, 110 in the cohort and 82 in the control.
The DGI showed 22% of the cohort participants were at risk
of falling compared to only 1% of those in the control group.
The M-CTSIB showed more than half (56%) of the cohort
participants were at risk of falling and only up to 21% in the
control group. The difference in fall-risk findings between
the two groups for both DGI and M-CTSIB was statistically
significant (
p
< 0.001). As expected, in both the DGI and
M-CTSIB assessments, in the cohort group, those with
symptoms of peripheral neuropathy and visual difficulties
showed an even higher prevalence of fall risk compared to
those without. In the cohort group, longer diabetes duration
and uncontrolled glycaemic status correlated with increased
risk of falling.
Conclusion:
This study determined in that young to middle-
aged South African adults with diabetes were at a higher
risk of falling when compared to those without diabetes.
These findings highlight the need to assess fall risk in young
to middle-aged patients with diabetes to enable early
identification and appropriate rehabilitation. Furthermore,
prevention of falls through health education and balance
screening in patients with diabetes may be a feasible
strategy to minimise the negative impact of falls and injuries
in a developing country such as South Africa.
Keywords:
diabetes, fall risk, middle age, adults, fall prevention,
rehabilitation
Introduction
Falls leading to accident or unintentional injury are the second
most prominent cause of death worldwide.
1
More than 80% of
fall-related injuries and fatalities occur in low- and middle-income
countries, therefore the prevention of falls is a major social and
public health concern for countries such as South Africa.
1
Falls are
not only associated with mortality, but are a concern, particularly
in resource-challenged settings such as South Africa, where
rehabilitation services including audiology and physiotherapy are
regarded as not widely available in most health centres, especially
the public sector. The number of fall-related injuries is predicted to
double by 2030 due to the increased risk of falls.
1-3
There are hundreds of risk factors for falls and the intrinsic
risk factors are related to individuals’ health profiles. Some of the
most important include: age, gender, balance and gait deficits,
medication, as well as limited vision.
1
There is also evidence in the
literature establishing diabetes as one of the possible contributors
to an increased risk of falling.
4-6
Diabetes is a metabolic disorder characterised by chronic
hyperglycaemia resulting from defects in insulin secretion, insulin
action or both.
7
Diabetes may contribute to increased risk of falls as
it is related to decreased sensorimotor function, musculoskeletal/
neuromuscular deficits, foot and body pain, pharmacological
complications and other co-morbidities.
4-6
It is estimated that 422 million people worldwide above 18 years
of age have diabetes and this number is projected to reach 642
million by 2040.
8
The high prevalence of diabetes and its projected
increase may imply an increase in the number of individuals at
risk of falls.
4,5
Falls in patients with diabetes may lead to physical
disabilities, affect the quality of life, and lead to an increase in costs
to the health system as a result of the increase in the number of
fall-related injuries and hospitalisations, as well as rehabilitation.
7
Several studies have reported on increased fall risk in patients
with diabetes.
3,4,6
However, some of these studies have several
methodological limitations that make it difficult to draw a clear
association between fall risk and diabetes.
6
Some of the noteworthy